Just before the summer break the Minister for Health announced the make up of the new Acute Hospital Group structures that will be established in the coming months. This new structure will see groups of hospitals brought together under one management structure, in the interests of efficiency, effectiveness, lack of duplication and clear lines of authority and autonomy.

As part of this reorganisation – and the INMO very much welcomes this – the Minister confirmed that a chief director of nursing post will be established within each hospital group. This person will work with the chief clinical director and chief executive officer to ensure consistency of approach and policy.

There was, and is, much comment, in relation to the make up of the groups but, for better or worse, they are now being established and the chairs of each hospital board, are to be announced shortly, with the appointment of senior management staff to follow thereafter.

However, despite this focus on the acute hospital sector, there appears to be little, or indeed no, clarity emerging on the shape, form and structures that will manage the remaining aspects of the health service. In particular the need to ensure that they liaise with – and dare I use the words ‘integrate with’ – the acute hospital sector.

In recent years we have moved from the directorate model, remember them from the initial HSE days of 2005, and the Primary, Continuing and Community Care (PCCC) division, to Integrated Service Areas (ISA) and now we are moving to something new again.

Throughout this void, which is unforgiveable, community-based services have had to continue with the delivery of an increased quantum of service with depleted resources without proper national direction and management. A particular casualty, of this limbo period, has been the core primary care service, in the community, namely our nursing service. We have seen the loss of posts, uncertainty about education and the increasing role of HIQA in the absence of long-term management structures.

Despite the lack of clarity, with regard to organisational/management structures, for the community and continuing care area, this has not stopped general management grades seeking to impose very significant changes upon the role of directors of nursing. They have attempted the abolition of director posts in both community and continuing care settings in recent months. This is opportunistic and fundamentally wrong when trying to ensure quality assured services are delivered.

Discussions are set to commence shortly, with the INMO and other health service unions, with regard to the reorganisation of our primary care structures following the rejection of the PCCC and ISAs. The INMO’s approach, to these discussions, will be that the management of these services should be, as close to the frontline as possible, and primarily headed up by a director of nursing who is in charge of all related services that form an integral part of the needs of the patient/ client in these environments.

The Minister has an obligation to deliver on his commitment to reorganise the health services, in the interests of the patients/clients and in a way that delivers the appropriate care, by the appropriate person, in the appropriate environment. We have moved on acute hospital structures but, as we look to the future, the critical area of community/primary care remains outstanding. This must be addressed immediately and current policy, which is negative towards frontline services, reversed.